Synopsis for November 23, 2001

Unexplained Deaths Following Knee Surgery  Minnesota, November 2001
The Minnesota Department of Health (MDOH) has received reports of three previously healthy persons who died unexpectedly following uncomplicated
knee surgery. CDC is assisting MDOH in the investigation of these events.

Mortality and malnutrition rates in the refugee crisis in Guinea were lower than expected, owing to the quick response of the international
community and the existing coping mechanisms of the refugees. During the crisis, refugees had lower mortality rates than baseline rates for the
local population. It is important to involve organizations with a mandate to care for these non-refugee populations early on in a crisis. Far
fewer refugees than anticipated were relocated. Establishing accurate rates with which to estimate the resources needed was extremely difficult
for this inaccessible and highly mobile population, and new methods to do this are needed.

Imported Wild Poliovirus Causing Poliomyelitis  Bulgaria, 2001

An outbreak of polio due to a poliovirus imported from India has been documented in Bulgaria.

PRESS CONTACT:
Mary Agocs, M.D., M.Sc.

CDC, National Immunization Program(404) 6398551

An outbreak of poliomyelitis due to an imported poliovirus strain has resulted in 3 proven cases in Bulgaria between March and May 2001. This
outbreak affected children from the Roma ("gypsy") minority in the Eastern city of Bourgas and the capital Sofia. Two additional
children, both Roma, were found to be healthy carriers of the wild virus. Bulgarian authorities implemented rapid outbreak control interventions
including vaccination of high-risk children immediately after the first case was diagnosed and two rounds of countrywide mass vaccination of
children in May and June. The World Health Organization alerted and assisted neighboring countries to strengthen poliomyelitis surveillance and
conduct local supplementary vaccinations. No other cases were found outside Bulgaria and the outbreak appears to be now under control.